More support needed for pregnant women

St John of God Health Care Perinatal Mental Health Psychiatrist Professor Marie-Paule Austin says the first report into mental healthcare in NSW has demonstrated the need to provide more emotional wellbeing support for women during pregnancy and early parenthood.

St John of God Health Care perinatal anxiety and depression29 August 2019

One of the key findings of the NSW Bureau of Health Information’s Healthcare in Focus report released last week found that mothers who reported a longstanding mental health condition gave less positive ratings of their maternity care experiences.

The report found that among those with a longstanding mental health condition, 63 per cent of women rated their care during labour and birth as very good, compared with 76 per cent of women with no mental health condition.

Professor Austin, who runs the only specialist mental health inpatient program in NSW for mothers and their babies up to 12 months of age at St John of God Burwood Hospital, said this finding was significant because it showed that vulnerable women were not getting the extra level of care they needed.

“This report really highlights that women with mental health conditions are not receiving the care they need and expect,” she said.

“Up to seven out of 10 women experience anxiety or depression during pregnancy or in the postnatal period after giving birth.

“We also know that women with more severe mental health conditions such as bipolar disorder or schizophrenia are more likely to present late for antenatal care and stop attending mental health care. This means they are getting suboptimal care in both instances.”

Mental health conditions are common

Mental health conditions were the most common longstanding condition reported by women surveyed for the report.

Professor Austin said this showed that the emotional needs of women during pregnancy should be given the same level of priority as their physical needs.

“Mental health conditions are as common as physical conditions such as diabetes and hypertension in pregnancy, yet these are often overlooked in favour of the mother’s physical care,” she said.

Screening women for mental health risk

In 2017, a mental health screening tool, the Antenatal Risk Questionnaire (ANRQ), developed by Professor Austin and her team, was included in new national guidelines designed to help improve the emotional wellbeing of pregnant women and new mums.

This means that the 300,000 or so Australian women having a baby each year now have their emotional wellbeing checked by clinicians during and after pregnancy as part of their routine maternity and postnatal care.

“This is enabling early identification of an episode or risk of relapse, creating opportunities for education, and early treatment, and is helping reduce the stigma by making mental healthcare part of mainstream services,” Professor Austin said.

Embedding mental health screening and support in maternity services was part of the recommendations made by Prof Austin and the advisory team in the 2017 national guidelines.

“This approach facilitates a mental health review which is especially important for women with a chronic mental health condition given they so easily drop out of care and thus increase the risk of poorer obstetric and neonatal outcomes,” Professor Austin said.

The Healthcare in Focus report compared the responses from 5,000 women in NSW, with the aim of getting a better understanding of how experiences of hospital care differ between mothers with lived experience of mental health issues and those without to improve maternity care.